Allow me to present a familiar scene. Imagine you and your significant other are about to take a trip after months of planning. Tickets have been purchased, reservations have been made and bags are packed. The night before departure, your toddler develops a cough. You might be asking yourself, “Why now and what should I do?”

When I first see children with a cough, I often ask questions about other aspects of their health. Do they have a significant fever? How is their appetite? How is their energy level? If these areas are abnormal, my ears perk up: this child may be fairly sick.

Next, I may ask about duration of the cough. Did this start a day or two ago? If the answer is yes, I may lean toward this being a self-limited viral upper respiratory infection. If the cough has persisted for multiple weeks, I may give stronger consideration to pertussis, bronchitis, asthma or other maladies.

Let me walk you through some of the things I look for during an exam that you can look for at home without a stethoscope. Initially, I try to determine if a child is very sick (and perhaps needs to be in the hospital) or if he or she is just feeling a bit under the weather.

If a child is experiencing abnormal breathing, we call this respiratory distress. Here are some signs that your child may be in respiratory distress. First, their nostrils may be flaring in and out due to rapid breathing. The child also may grunt when trying to breathe. When you look at the skin between the ribs, it may move in-and-out quickly; we call these retractions. The fingers and toes may have a bluish hue, suggesting the child is not getting good oxygenation to the extremities. These are all reasons to be seen right away at an emergency room.

I mentioned earlier about appetite and energy level. If a baby or toddler can’t feed well because of difficulty breathing, that is a red flag. A significant decrease in wet diapers suggests dehydration. Finally, if a child is lethargic and difficult to arouse, that is another reason to be seen right away.

For kids with milder symptoms, a question I hear often is will cough medicine help? The answer will vary by physician, but I would say in most cases that cough medicines are not particularly helpful. You would think with the amount of over-the-counter medications available they would be very helpful, but that has not been found to be the case. And in toddlers, some cold medications are no longer made because of adverse reactions.

Sometimes a child can have a significant and persistent cough and when you take them to see a doctor you don’t leave with an antibiotic prescription in hand. That is because many causes of cough do not warrant an antibiotic. Viral upper respiratory infections, RSV (respiratory synctial virus), and bronchitis don’t respond to antibiotics. When you don’t receive an antibiotic, please resist the urge to think negative thoughts about your provider; medical professionals truly have your best interests in mind.

So let’s reconsider the article’s headline: When should you see a doctor for a cough? Long duration, fever, lethargy, poor oral intake and respiratory distress are good reasons to pay a doctor a visit. For less severe and mild symptoms, it might be wise to stick to ensuring adequate rest and good hydration for a few days. If the symptoms don’t improve on their own a visit may be warranted. And if you read last issue’s installment on immunizations, thanks for being immunized against pertussis and the flu; I won’t get to see you quite as much.